Healthcare Provider Details

I. General information

NPI: 1780074146
Provider Name (Legal Business Name): VIGNENDRA ARIYARAJAH MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4713 CHURCH AVE.
BROOKLYN NY
11203-3209
US

IV. Provider business mailing address

845 GARDEN ST
HOBOKEN NJ
07030-4101
US

V. Phone/Fax

Practice location:
  • Phone: 718-946-5915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIGNENDRA ARIYARAJAH
Title or Position: MD
Credential:
Phone: 718-946-5915